Urolithiasis in pregnancy - Obstetric and urologic complications

Abstract

Objective: Urolithiasis in pregnancy, though unusual, is a common non obstetric cause of acute abdomen requiring hospitalization. It often presents a unique challenge in diagnosis and management, since presence of a gravid uterus masks or alters the clinical presentation and limits the imaging modalities that can be used for diagnosis, along with restricting the treatment options. When diagnosed during pregnancy renal stones can affect the course of pregnancy and its outcome. The objective of present study was to highlight these problems and discuss the management options. Methods: Antenatal women, diagnosed as urolithiasis were studied prospectively for their clinical course, investigated and treated conservatively. Results: All women displayed complete range of symptoms from asymptomatic bacetruria, pyuria, hydronephrosis, hydroureter, to renal failure. Obstetric complications were premature rupture of membranes, preterm labor and IUGR. All except two patients benefitted by non surgical treatment. Conclusion: When encountered in pregnancy urolithiasis can be a diagnostic challenge. Ultrasonography is a safer modality for diagnosis though a limited urography can be done if necessary. Conservative treatment works well for most patients, projesterone helps in aiding spontaneous expulsion of calculi. Percutaneous nephrostomy or double J stenting of ureters can be done to temporarily relieve ureteric obstruction.